This inspection took place on 4 and 12 May 2017 and was announced. This was to ensure someone would be available at the service to speak with us and show us records. We visited the service on 4 May 2017, and spoke with family members on the telephone on 12 May 2017.

Hawthorn House provides a short break service for up to ten people who have a learning disability, some of whom may also have a physical disability. On the day of our inspection there were three people using the service however there were 70 people in total who used the respite service.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager of the service had applied to become registered with CQC and the application was in progress at the time of the inspection.

Hawthorn House was last inspected by CQC on 10 March 2016 and was rated Requires Improvement in two areas. We checked these areas at this inspection and the found necessary improvements had been made.

Accidents and incidents were appropriately recorded and risk assessments were in place. The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. At our last inspection we found that appropriate recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. We did not check staff recruitment records at this inspection because there had been no new staff recruited.

Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were supported with their health care needs and care records contained evidence of consultation with health care professionals.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Family members were complimentary about the standard of care provided by staff at Hawthorn House.

Staff treated people with dignity and respect and helped promote people’s independence.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their individual needs.

The registered provider had an effective complaints procedure in place however there had been no formal complaints recorded at the service.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

We inspected Hawthorn House on 10 March 2016. This was an announced inspection. We informed the registered provider at short notice that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day and we needed to be sure that someone would be in.

Hawthorn House is a purpose built single storey building which provides a short break service for up to ten adults aged 18 and above who have a learning disability, some of whom may also have a physical disability. It is located on the outskirts of Durham City.

The home had a manager who was not yet registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager told us they were in the process of completing their application to become the registered manager.

The manager and staff showed that they had an understanding on the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Professionals had completed capacity assessments on people who used the service; however decision specific assessments of capacity were not available on care records we looked at. Best interest decisions were not always recorded.

Staff had received regular updates on their training to enable them to carry out the duties within their role; however the training chart needed further development to detail the dates of staff training and all the training staff had completed.

People were protected by the service's approach to safeguarding and whistle blowing. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building, equipment and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as choking, mobility, community participation and behaviour that challenges amongst others. This meant staff had the written guidance they needed to help people to remain safe.

We found that safe recruitment and selection procedures were in place and appropriate checks were completed before staff started work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. Sufficient staff were on duty to ensure people’s needs were met.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Regular temperature checks were made of the room in which medicines were stored and on some occasions the room temperature was too warm. This meant that some medicines could deteriorate and be ineffective. The manager said they would monitor temperatures and take action if needed.

Staff told us that they felt supported. There was a programme of staff supervision in place. Records of supervision were detailed and showed that the manager had worked with staff to identify their personal and professional development goals. Staff had received an annual appraisal.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw that staff treated people with

During our inspection we spent time talking with people who were staying at Hawthorn House and watched how staff gave them support and care. We found peoples’ care and welfare needs were met in a way which ensured their safety. People told us “They (the staff) are nice. They take me out to the shops and out in the bus.” One person said “I like coming here, I get a break from my sister(relative ).” Another person told us “The staff help me to do things I like. I went to the leisure centre yesterday.”

People who used the service were protected from the risk of abuse or harm. This was because staff understood about the risk of abuse and what to do should they suspect or see this happening. People told us “I would talk to the staff if I was unhappy.”

We found staff were properly trained and supported and understood the care and welfare needs of the people they supported.

The manager and senior staff carried out regular checks to make sure good standards of care were provided to people.

We met with four people who used the service and spoke with two relatives over the telephone.

One of the people who used the service was able to tell us their views. They said “I have good times here, the staff are smiley. I can have a lie in if want to. They changed my room because the DVD wasn’t working.” They also told us they would definitely come back to Hawthorne House.

When we visited, three people were unable to tell us directly about their experiences and views of their care. Therefore, we watched staff practices as they supported people. We heard staff address people respectfully and explain to people the support they were providing. Staff were friendly and very polite and understood the support and communication needs of people in their care. Staff waited for people to make decisions about how they wanted their care to be organised and closely followed people’s way of communicating.

Relatives said “Hawthorne House definitely involved me in writing my son’s care plan. I had to sign something to say it was alright for them to go ahead with any emergency medical attention my son might need.” They told us they would feel able to make a complaint and they knew the staff well enough to raise any concerns with them. They also told us they were always asked to complete a form before each stay to tell the staff about any changes to their family member’s health care needs.

There was only one person staying at the home the day we visited. We were not able to communicate directly with this person and could only observe. We did not observe anything that gave us cause for concern.

“I like the staff”,

“I like it here better than the day centre, it’s too noisy there”.

“There are plenty of staff around”,

“I have my own bed and TV here”,

“We get tea, orange and supper when its time for bed, biscuits cakes and sandwiches”,

“We have barbeques outside in the summer”,

“I use the buzzer to lift my bed up and down”

“I can lock my bedroom door if I want to”,

“The foods alright but I’m not sure what’s for tea” and

“You’re not allowed in the kitchen, it’s too dangerous”.

During our inspection we asked the provider and staff specific questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff. Systems were in place to make sure that the acting manager and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be made. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required by the law.

Staff recruitment practice was safe and thorough. This meant only suitable people were employed with the right skills and experience.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, social, mobility, equipment and needs in relation to their learning disability had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. Relatives had commented “Name of person seems to have settled well” and “All staff were exemplary and could not have been more helpful.”

People’s preferences, interests, likes, dislikes and different needs were written down in their support plans. This helped to make sure support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service. The home had its own adapted minibus which helped people become involved with the local community.

The home had an effective complaints procedure. We looked at how complaints had been dealt with and found that responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies, such as social workers, to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed quickly. This helped to ensure that people received a good quality service at all times.